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Age and Ageing 2006 35(5):542; doi:10.1093/ageing/afl091
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical Reminder

The purple urine bag syndrome

J. Beunk, M. Lambert and T. Mets*

Geriatrics, Department of Internal Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, B-1090 Brussels, Belgium Tel: (+32) 2 477 63 66; Fax: (+32) 2 477 63 64; Email: tony.mets{at}az.vub.ac.be

* To whom correspondence should be addressed

One day after insertion of a urinary catheter, a 93-year-old woman, hospitalised for pelvic fracture, presented with an intense purple discolouration of the urine and the drainage system (see Figure 1 in the supplementary data on the journal website, http://www.ageing.oxfordjournals.org/;). However, colour of the urine entering the catheter was normal.

This is a typical case of purple urine bag (PUB) syndrome [1]. The colour is seen when the pigments indirubin or indigo blue interact with the plastic of the catheter or urine bag. These pigments develop by the transformation of indoxyl sulphate (a metabolite of tryptophan) because of the presence of urinary bacteria possessing indoxyl phosphatase/sulphatase activity (mainly Pseudomonas aeruginosa, Proteus mirabilis, Morganella morganii, Escherichia coli, Providencia stuartii and Providencia rettgeri). PUB syndrome is considered to be harmless, does not influence the outcome of patients and disappears after treatment of the urinary tract infection. No special investigations should be undertaken [2, 3].


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  • Infrequent condition, mainly seen in elderly patients, characterised by purple colouring of urine, only when in a plastic collection system.
  • The purple colour is due to a chemical reaction involving urine, plastic and enzymes from some bacteria.
  • PUB syndrome is harmless, and no additional investigation is needed.


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None.


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  1. Barlow GB, Dickson JAS. Purple urine bags (Letter). Lancet 1978; i: 220–1.
  2. Dealler SF, Hawkey PM, Millar MRI. Enzymatic degradation of urinary indoxylsulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. J Clin Microbiol 1988; 26: 2152–6.[Abstract/Free Full Text]
  3. Ishida T, Ogura S, Kawakami Y. Five cases of purple urine bag syndrome in a geriatric ward. Nippon Ronen Igakkai Zasshi 1999; 36: 826–9.[Medline]

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This Article
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